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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Sero-epidemiological case control studies have observed positive relations between infections with Chlamydia pneumoniae, Helicobacter pylori or cytomegalovirus (CMV) and the occurrence of coronary artery disease (CAD) and stroke. Moreover, positive relations between 'infection burden' and CAD and the role of inflammation have recently been described. However, the relations between infection, inflammation and the occurrence of peripheral arterial disease (PAD) have not been reported so far. We performed a multi-centre population-based case-control study, using serum samples of 228 young female PAD patients and 643 control women to determine IgG antibody titres and C-reactive protein. The odds ratios for PAD in women with serological evidence for infection with C. pneumoniae, H. pylori or CMV were 2.0 (95% CI; 1.3-3.1), 1.6 (95% CI; 1.1-2.2) and 1.6 (95% CI; 1.1-2.3), respectively. The cumulative number of infections was positively related to the risk of PAD; the odds ratio was 1.5 (95% CI; 1.0-2.4), 2.7 (95% CI; 1.6-4.4) and 3.5 (95% CI; 1.5-8.1) for women with one, two or three infections, respectively. This increased risk, related to the 'infection burden', was found again in the subgroup of women with a high CRP level, but not in the subgroup with a low CRP level. Infections might be a causal component in the development of PAD. The risk of PAD is not only related to a single pathogen in particular, but also to the cumulative number of infections. The positive relation between 'infection burden' and PAD was only found in women with a high CRP level, which indicates that inflammation might be involved in the process that leads to PAD.
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PMID:Chlamydia pneumoniae, Helicobacter pylori and cytomegalovirus infections and the risk of peripheral arterial disease in young women. 1204 33

Recently, a growing number of epidemiological, histopathological and microbiological studies have shown that chronic Chlamydia pneumoniae (C. pneumoniae) infection accelerates the progression of atherosclerosis of carotid and cerebral arteries and thus could constitute a risk factor for stroke. We present a number of mechanisms postulated in recent papers that link C. pneumoniae infection with the development of atherosclerosis. The one most important seems to be the effect of activation of nuclear factor--kappa B and the phenomenon of antigenic mimicry between human and C. pneumoniae heat shock proteins. We also discuss the problem of immunological reaction against myosin filaments of carotid artery wall smooth muscle cells and the problem of antigenic mimicry between heavy chains of myosin filaments and antigens presented on C. pneumoniae outer membrane.
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PMID:[Effect of Chlamydia pneumoniae infection on carotid atherosclerosis development]. 1205 4

Patients in the acute phase of a stroke ought to be sent to a centre with a well-organised 'stroke unit' where thrombolysis is possible. The integrated approach at a stroke unit is associated with a better outcome than treatment in a general neurology ward. Intravenous thrombolysis can be carried out responsibly if the treatment is started within 3 hours of the onset of clinical symptoms and if certain conditions are satisfied. However, preventive measures provide the greatest benefit to patients who have experienced a transient ischaemic attack (TIA) or a minor stroke. The treatment of vascular risk factors should therefore receive the greatest priority. In addition to the classical risk factors, hyperhomocysteinaemia, infection with Chlamydia pneumoniae and obesity have all recently been indicated as potential risk factors. For patients with a potential source of embolism in the heart, oral anticoagulants are the treatment of choice, whereas platelet aggregation inhibitors should be the first choice for patients with atherosclerotic lesions in the extracranial vessels. Carotid endarterectomy is now a regular form of secondary prevention, whereas the role of endovascular treatment is currently under investigation.
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PMID:[Treatment of patients with a TIA or a stroke]. 1251 Apr 9

The occurrence of cerebral or retinal ischemic symptoms ipsilateral to high-grade internal carotid artery (ICA) stenosis indicates a status of instability with a substantial risk for future major stroke. Additionally, the detection of microembolic signals downstream of ICA stenosis is predictive for future cerebral ischemia in asymptomatic and symptomatic patients. There is substantial evidence that in unstable ICA stenosis plaque rupture and thrombus formation are the most frequent pathoanatomic findings. In contrast, in nearly the half of unstable carotid plaques the lumen surface appears to be intact. Within plaque tissue, the unstable plaque is mainly characterized by a substantial amount of inflammatory cell (i. e. macrophages, T-cells) infiltration. These cells are mainly localized in the fibrous cap near the necrotic core. Produced by macrophages, matrix degrading enzymes (e. g. MMP-9) are overexpressed in the unstable ICA stenosis. Thrombogenicity is mainly determined by the local concentration of activated tissue factor, also expressed by inflammatory cells. Furthermore, a significantly higher rate of apoptotic smooth muscle cells can be found within the fibrous cap of instable carotid stenoses. Whether infection with Chlamydia pneumoniae contribute to instability is unlikely, because a positive association to clinical instability has not been shown up to now. The exact and detailed characterization of the unstable ICA plaque and the correlation of different biological mechanisms to clinical instability may offer the possibility to use it as a human model of unstable atherosclerosis in general and to test the efficacy of new developed anti-atherosclerotic pharmaceutical agents.
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PMID:[The unstable carotid stenosis: definition and biological processes]. 1273

Current topics and new developments in risk factors for ischemic stroke were reviewed. Hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation, cigarrette smoking, and heavy alcohol drinking have been established as being common treatable risk factors for stroke. Recent studies have clarified that homocysteine, various cardiac sources of embolism such as patent foramen ovale, antiphopholipid antibodies, lipoprotein (Lp) abnormalities including Lp(a) and remnant-like particle, insulin resistance or hyperinsulinemia, infectious diseases such as Chlamydia Pneumoniae, and CRP are additional risk factors for stroke. In addition, genetic studies using single nucleotide polymorphisms have suggested that many gene polymorphisms are significant risk factors for certain subpopulations of stroke, which is recognized to be a polygenic disease. Management of these risk factors is crucial for primary prevention of stroke, which is the leading cause of death or disability all over the developed countries.
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PMID:[Risk factors for cerebral infarction: current topics and new developments]. 1278 67

The authors report results of a retrospective pilot study showing a strong association between patients with stroke/TIA and the presence of circulating IgG and IgA antibodies to Chlamydia pneumoniae. These results support the hypothesis that chronic active or persistent infection may play a role in the mechanism of thrombosis. The risk for stroke associated with Chlamydial circulating antibodies appeared to be independent of other risk factors such as diabetes and hypercholesterolemia.
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PMID:Evidence of an association between Chlamydia pneumoniae and cerebrovascular accidents. 1282

Heart disease and stroke are the result of atherosclerotic vascular lesions. It is becoming increasingly clear that an infection may be an important initiating component within the atherogenic process. However, in order for the infection to contribute to atherosclerosis, it must first be capable of disseminating to the vessel wall. Chlamydia pneumoniae is an example of an infectious atherogenic stimulus. The present treatise reviews our knowledge concerning dissemination of infectious agents like C. pneumoniae. Three factors can be identified that modulate the severity of the infection in the vascular wall. First, although all vascular cell types appear to be infected with agents like C. pneumoniae, there are differences in the sensitivity to infection amongst these cell types. Second, the lipid environment is important in defining the effects of C. pneumoniae on atherosclerotic disease. Third, the inflammatory/atherosclerotic interaction is influenced by the specific infectious stimuli employed. The in situ atherogenic effects of C. pneumoniae may be specific to this organism and may not occur with related infectious agents like C. trachomatis. Despite the identification of these three factors, controversy exists surrounding specific characteristics of these effects. This may be the result of a plethora of differing experimental conditions (different labs, different lipids, different cell types or lines, and different C. pneumoniae characteristics (infection, dosage, duration, etc.)). Further study of these important phenomena is clearly warranted in view of the potential importance of infection to the atherosclerotic disease.
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PMID:Dissemination of Chlamydia pneumoniae to the vessel wall in atherosclerosis. 1284 48

There is an increasing body of evidence that links Chlamydia pneumoniae infections to atherosclerosis and the clinical complications of unstable angina, myocardial infarction and stroke. Several epidemiologic reports indicate an association between the presence and titer of Chlamydia pneumoniae antibodies and atherosclerosis and its complications. Other studies show the presence of Chlamydia pneumoniae, chlamydial antigens or nucleic acid in atherosclerotic plaques. Moreover, experimental studies present mechanisms by which Chlamydia pneumoniae may play a role in the induction of atherosclerosis and its complications. Finally, many studies have evaluated the effect of antibiotic treatment on cardiovascular events in humans. This article reviews all the aspects that link Chlamydia pneumoniae to atherosclerosis and its clinical manifestations.
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PMID:[Chlamydia pneumoniae, atherosclerosis, and coronary disease]. 1284 76

Infection with Chlamydia pneumoniae has been suggested to play a role in the development and maintenance of atherosclerosis based on differences in the prevalence of antibodies against Chlamydia pneumoniae in patients with and without atherosclerotic lesions. We evaluated the prevalence of Chlamydia pneumoniae DNA in the white cells of the peripheral blood in 194 patients with diabetes mellitus, 50 patients with acute coronary syndrome, 102 hypertensive patients, 193 patients having suffered a stroke and in 368 healthy subjects with a nested polymerase chain reaction (nPCR). Overall the prevalence of Chlamydia pneumoniae DNA in peripheral blood cells was: diabetes mellitus (11.9%), stroke (10.4%), hypertension (6.9%), acute coronary syndrome (4.0%) and healthy subjects (7.9%). The prevalence of Chlamydia pneumoniae DNA in the patients was not significantly different from prevalence in the healthy subjects. However, a significant association was found between high levels of triglycerides and presence of C. pneumoniae DNA (OR = 3.27, p < 0.04). The prevalence of C. pneumoniae DNA was not associated with age, gender, smoking, BMI, HDL, CRP, plasma creatinine and symptoms or signs of ischaemic heart disease. The association between high levels of triglycerides and C. pneumoniae DNA suggests that infection by C. pneumoniae affects lipid metabolism.
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PMID:Chlamydia pneumoniae DNA in peripheral blood mononuclear cells in healthy control subjects and patients with diabetes mellitus, acute coronary syndrome, stroke, and arterial hypertension. 1460 8

Stroke is a disease with well-defined modifiable risk factors such as arterial hypertension, smoking, diabetes, hyperlipidemia and atrial fibrillation. The need of new risk factors is based on the fact that only half the cardiovascular disease risk is explained by conventional risk factors. Inflammatory markers, infection, homocysteine and sleep-disordered breathing rank as the four most important new risk factors in cerebral atherosclerosis. C-reactive protein is the inflammatory marker that has been most thoroughly studied. Elevated concentrations of C-reactive protein increase the risk of heart disease and thromboembolic stroke in men and women. The role of Chlamydia pneumoniae is still controversial. Influenza vaccination is a simple and effective preventive measure against stroke. Despite the potential relationship between homocysteine and stroke, we should wait to the results of the ongoing trials to know if the reduction of homocysteine levels with vitamin therapy is of clinical benefit. Sleep-disordered breathing is a potential new risk factor with an effective therapy. Neurologists should not forget to look for sleep disorders in their stroke patients and probably manage them with breathing therapy from the acute phase.
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PMID:Cerebral ischemia: new risk factors. 1469 79


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